OPEN FORUM: San Francisco must address cause of health disparities — a history of housing discrimination

“The South is not half as bad as San Francisco ... The white man ... he’s not taking advantage of you out in public like they doing down in Birmingham. But he’s killing you with that pencil and paper, brother.”

— An unnamed, 20-year old African American San Francisco resident in the 1964 KQED documentary, “Take This Hammer”

“This is the San Francisco (that) Americans pretend does not exist. They think I’m making it up.”

— Writer and activist James Baldwin, commenting on the young man’s statement in the documentary.

Black History Month is a time to celebrate great African American achievements. This year, however, our attention is turned toward the thousands of young black Americans who never have the opportunity to reach their full potential. As members of UCSF White Coats for Black Lives, we are focused on solutions that address the persistent disparities that harm our patients’ health. We call on San Francisco politicians to address racial discrimination in housing legislation as a root cause of the health disparities we see in clinics and hospitals.

According to the most recent data from the San Francisco Department of Public Health, black infants make up only 5 percent of births, but make up 23 percent of infant deaths due to perinatal conditions such as pregnancy complications and low birth weight. Black children constitute 9 percent of public school students in San Francisco, yet they make up nearly 20 percent of students in its lowest-rated schools. Children and their families endure these inequities despite San Francisco’s unprecedented wealth and cutting-edge health care.

How did we get here? The answer has a lot to do with our history.

Home Owners' Loan Corporation 1935 map, commissioned by the Federal Home Loan Board, that designated and ranked different neighborhoods according to suitability for mortgage lending. Its designations are largely based on racial makeup. The designated color codes are "best" (green), "still desirable" (blue), "definitely declining" (yellow) and "hazardous" (red.)

Photo: Home Owners' Loan Corporation / Public documents archive

Redlining refers to the practice of racial discrimination in mortgage lending that began under President Franklin Delano Roosevelt’s New Deal. This practice decimated economic opportunities for black Americans at a time when white Americans were offered government-sponsored opportunities to build wealth through homeownership. San Francisco was no exception.

The Home Owners’ Loan Corporation map of San Francisco included explicitly racist descriptions of neighborhoods, demonstrating that the value assigned to a neighborhood was directly tied to its racial demographic. The description for one “red-lined” district reads: “There is a decided concentration of undesirable racial elements. More than half the Negro population of San Francisco are located here, and it is considered a highly hazardous area.”

Redlining (systematically denying mortgage loans, insurance or other lending in neighborhoods lenders drew red lines around) led to decades of disinvestment in black neighborhoods and segregation that endures.

Nearly 90 years later, the repercussions of redlining are pervasive and continue to harm the descendants of those who lived in these communities. A study by the National Community Reinvestment Coalition released last year found that nearly 70 percent of previously redlined neighborhoods in San Francisco are still minority-majority neighborhoods and more than half of those neighborhoods are struggling economically.

Today, neighborhoods that were intentionally cut off from economic opportunity during the New Deal era have the highest rates of preterm birth and the lowest performing schools. San Francisco is failing its children in the context of its enormous wealth and progressive values. The maps illustrating the segregation of preterm births and low-achieving schools make a clear case that not being racist today doesn’t correct for racism in the past. In order to move forward as a city, San Francisco must atone for its past wrongdoing.

Preterm birth rates in San Francisco by ZIP code, 2012-2016.

Photo: San Francisco Department of Public Health / California Department of Public Health

San Francisco’s preterm birth outcomes and segregated school performance are only two examples that reflect historical inequities that continue to plague us.

In 2017, San Francisco legislation granted neighborhood preference for 40 percent of new units in the affordable housing lottery system. But this is only a small step in the right direction.

After the passage of this legislation, Mayor London Breed said, “I don’t know who is winning the lottery. But I know who is losing. African Americans at an alarming rate have left this city.”

In order to substantially curb the unjust loss of residents to gentrification, San Francisco must create a broad-reaching program that subsidizes homeownership for longtime residents of historically red-lined districts. As the Board of Supervisors prepares the budget for the upcoming fiscal year, it is imperative that city officials prioritize policies that promote equitable wealth-building for those who historically have been deliberately neglected and dis-invested.

If San Francisco is to ensure that its children have equal access to life, education and opportunity, it must return what is owed.

Jazzmin Williams and Laeesha Cornejo are first-year-medical students at the University of California, San Francisco, and are members of the Program in Medical Education for the Urban Underserved. They are actively involved in the UCSF chapter of White Coats for Black Lives, which was founded in 2014 in response to police violence against black Americans. The organization strives to disrupt systemic racism and its effect on the health of communities of color.